1033281464 NPI number — MR. RONALD M D ANGELO M.S. CCC-A

Table of content: MR. RONALD M D ANGELO M.S. CCC-A (NPI 1033281464)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033281464 NPI number — MR. RONALD M D ANGELO M.S. CCC-A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
D ANGELO
Provider First Name:
RONALD
Provider Middle Name:
M
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.S. CCC-A
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033281464
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/16/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 406153
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30384-1876
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-227-9920
Provider Business Mailing Address Fax Number:
585-225-6574

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
121 ERIE CANAL DR
Provider Second Line Business Practice Location Address:
STE. E
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14626-4605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-227-9920
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  001993 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 11545677 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 179756AI . This is a "PREFERRED CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P010001993 . This is a "EXCELLUS ROCHESTER REGION" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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